The National Health Commission (NHC) of China, in conjunction with nine other ministries, has issued comprehensive guidelines aimed at bolstering the construction of compact county-level medical care communities. The initiative seeks to enhance the efficiency of medical resource allocation and utilization, synchronize the development and governance of medical insurance, healthcare, and pharmaceuticals, and establish a tiered diagnosis and treatment system.
Targets Set for 2024 and 2025
The government has set a target to fully promote the construction of compact county-level medical communities at the provincial level by June 2024, with significant progress expected in their organizational and management policies by the end of 2025. The guidelines promise investment guarantees, personnel arrangements, salary and benefits, and medical insurance payments for these communities. The goal is to establish county-level medical communities with unified management of personnel and property, clear rights and responsibilities, efficient operation, and a clear division of labor in over 90% of counties nationwide by 2025, with full national coverage projected by 2027.
Resource Allocation Strategy
County-level medical communities will be established based on geographical location, population size, and the current layout of medical and health institutions. These communities, led by county-level hospitals, will include township health centers and community health service centers. The leading hospitals should be non-profit, Class 2 or above comprehensive or traditional Chinese medicine hospitals. Class 2 and 3 hospitals are encouraged to enhance community service capacity through expert deployment and joint initiatives. Public Class 3 hospitals in cities are required to send at least three experts to provide year-round guidance in various medical fields. Each township health center should have at least one lead hospital attending physician or above with a professional title serving year-round.
Payment Model Innovations
Compact county-level medical communities will adopt a medical insurance fund global budget model. Authorities will assess medical expense growth rates, reimbursement ratios, and fund expenditure ratios, improving the mechanism for surplus retention, which will be used as business income for county-level medical communities. A reasonable mechanism for sharing overspending will be established, promoting payment based on diagnosis-related groups (DRGs) or the diagnosis-intervention packet (DIP) system. The goal is to gradually implement payment for the same disease at the same rate across different levels of medical institutions, supporting the development of rural medical and health institutions and promoting tiered diagnosis and treatment. The general diagnosis and treatment fee policy will be aligned with the medical insurance fund’s capacity and patient affordability.- Flcube.com
